In a population-based cohort study involving nontrauma, non–cardiac arrest adult patients transported to the hospital by the greater King County, Washington, emergency medical service system, Seymour and colleagues Article assessed out-of-hospital clinical predictors of critical illness and the performance of a simple score for out-of-hospital prediction of critical illness during hospitalization. The authors found that a prediction score that included age, systolic blood pressure, heart rate, respiratory rate, Glasgow Coma Scale score, and pulse oximetry was associated with the development of severe sepsis, the need for mechanical ventilation, or death during hospitalization. In an editorial, Wang and Yealy Article discuss the application and clinical utility of a critical illness emergency medical service decision rule.
Postoperative sternal wound infection is a serious problem after cardiac surgery procedures. In a randomized trial involving 1502 cardiac surgery patients at increased risk of sternal wound infection from diabetes, body mass index greater than 30, or both, Bennett-Guerrero and colleagues assessed whether insertion of a gentamicin-collagen sponge between the sternal halves at wound closure would prevent infection. All patients received standard care including prophylactic systemic antibiotics and rigid sternal fixation. The authors report no difference in the rate of sternal wound infection among patients in the gentamicin sponge vs no-intervention groups.
In an analysis of population-based data from Danish patients with ST-segment elevation myocardial infarction (STEMI) transported by the emergency medical service and treated with primary percutaneous coronary intervention, Terkelsen and colleagues examined the relationship between system delay—defined as the time between contact with the emergency medical service to initiation of reperfusion therapy—and mortality. In analyses that adjusted for clinical predictors of mortality, the authors found that health care system delay was independently associated with mortality.
Shargorodsky and colleagues analyzed data from 2 nationally representative surveys—the Third National Health and Nutrition Examination Survey (NHANES III), conducted in 1988 through 1994, and NHANES 2005-2006—to assess the current prevalence of hearing loss in US adolescents and to determine whether the prevalence has changed over time. The authors found that the prevalence of any hearing loss among US adolescents increased significantly from 14.9% (95% confidence interval, 13.0%-16.9%) in 1988-1994 to 19.5% (95% confidence interval, 15.2%-23.8%) in 2005-2006.
In a systematic review of evidence relating to the accuracy of bedside instruments to diagnose delirium in adults, Wong and colleagues found several sensitive, specific, rapid, and simple-to-administer instruments for assessment of delirium. The choice of instrument may be dictated by the amount of time available to complete the patient assessment and the discipline of the examiner.
“I suddenly felt safe. If I were in trouble, I reasoned, this experienced physician would see it instantly and take the right action. He wouldn't let anything happen.” From “Journalist Feels Palpitations, Enrolls in Medical School.”
It is feasible to eliminate or minimize industry funding of continuing medical education, but this process is not without challenges, according to institutions working to implement such changes.
From the Archives Journals
An article in the July Archives of Dermatology reports that obesity at age 18 years is associated with an increased risk of psoriatic arthritis. Gladman and Callen discuss characteristics of and risk factors associated with psoriatic arthritis and potential opportunities for intervention.
US global health initiative
Minimizing bias in randomized trials
Physician compensation, cost, and quality
Join Matthew K. Wynia, MD, MPH, Wednesday, September 15, from 2 to 3 PM eastern time to discuss the role of professionalism and self-regulation in medicine. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about delirium.
This Week in JAMA . JAMA. 2010;304(7):715. doi:10.1001/jama.2010.1163